Shared Decision-Making With a Virtual Patient in Medical Education: Mixed Methods Evaluation Study

Abstract

Background Shared decision-making (SDM) is a process in which clinicians and patients work together to select tests, treatments, management, or support packages based on clinical evidence and the patient’s informed preferences. Similar to any skill, SDM requires practice to improve. Virtual patients (VPs) are simulations that allow one to practice a variety of clinical skills, including communication. VPs can be used to help professionals and students practice communication skills required to engage in SDM; however, this specific focus has not received much attention within the literature. A multiple-choice VP was developed to allow students the opportunity to practice SDM. To interact with the VP, users chose what they wanted to say to the VP by choosing from multiple predefined options, rather than typing in what they wanted to say. Objective This study aims to evaluate a VP workshop for medical students aimed at developing the communication skills required for SDM. Methods Preintervention and postintervention questionnaires were administered, followed by semistructured interviews. The questionnaires provided cohort-level data on the participants’ views of the VP and helped to inform the interview guide; the interviews were used to explore some of the data from the questionnaire in more depth, including the participants’ experience of using the VP. Results The interviews and questionnaires suggested that the VP was enjoyable and easy to use. When the participants were asked to rank their priorities in both pre- and post-VP consultations, there was a change in the rank position of respecting patient choices, with the median rank changing from second to first. Owing to the small sample size, this was not analyzed for statistical significance. The VP allowed the participants to explore a consultation in a way that they could not with simulated or real patients, which may be part of the reason that the VP was suggested as a useful intervention for bridging from the early, theory-focused years of the curriculum to the more patient-focused ones later. Conclusions The VP was well accepted by the participants. The multiple-choice system of interaction was reported to be both useful and restrictive. Future work should look at further developing the mode of interaction and explore whether the VP results in any changes in observed behavior or practice.

The Agreement Between Virtual Patient and Unannounced Standardized Patient Assessments in Evaluating Primary Health Care Quality: Multicenter, Cross-sectional Pilot Study in 7 Provinces of China

“…Specifically, our results showed that the recall score for medical history for the VP testing was two-thirds of the score for USP testing, while the corresponding VP score for physical examination was more than twice that of the USP score. These findings indicate that multiple choices might provide more hints, allowing PHC providers to guess a correct action more easily [ 14 , 26 ]. Although searching for keywords for consultation or actions leads to less bias than the hints provided by multiple choices, this interface might decrease the usability of VPs, particularly when the interaction does not provide enough options or fuzzy searches.…”

“…There is some evidence that VP user interfaces and usability may influence VP-based assessment outcomes [ 14 , 25 ]. The extent to which a VP may serve as a quality assessment tool needs further research [ 26 , 27 ].…”

Virtual simulation tools for communication skills training in healthcare professionals: an integrative review of the literature (Preprint)

“…One of the tools could be defined as partially autonomous because a trained instructor had had to perform some of the functions (Ochs et al, 2019). Regarding the patient type employed for the training, the vast majority of the tools had used virtual patients (n = 19; 79.17%) with the appearance of a real person (Ali et al, 2020;Bánszki et al, 2018;Borja-Hart et al, 2019;Chae et al, 2023;Deladisma et al, 2008;Du et al, 2022;Guetterman et al, 2019;Hwang et al, 2022;Jacklin et al, 2021;Kleinsmith et al, 2015;Maicher, Kellen R. et al, 2019;Ochs et al, 2019;Perez et al, 2022;Plass et al, 2022;Real, Francis J., MD et al, 2017;Rouleau et al, 2022;Sapkaroski et al, 2022;Sezer & Sezer, 2019;Shorey et al, 2020). Of these, 94.74% (n = 18/19) had responded with a voice (n = 18/24; 75%), except for the tool published by (Du et al, 2022).…”

“…A second objective was to involve patients in the design of a virtual patient simulation and inform the design process. (Jacklin et al, 2021) United Kingdom…”

Empathic communication training in healthcare using Virtual Patients

“…Through the collaboration, the researchers noted the need to improve the delivery of feedback to students as part of the training. The tool was effective in changing medical students' attitudes regarding the value of patient focus and shared decision-making (Jacklin et al, 2021). Foster et al (2016) showed the importance of feedback on students' empathic responses in interactions with VPs.…”